Health care providers' use of a drug information service for pregnancy-related inquiries.

OBJECTIVES: To characterize pregnancy and lactation-related medication inquiries to a drug information center to identify classes of medications of most concern to providers. A secondary objective was to identify any trends in provider inquiries over the study period. DESIGN: A retrospective descriptive study of pregnancy and lactation-related inquiries to the University of North Carolina Health Care System Drug Information Center database between January 2001 and December 2010. SETTING: University of North Carolina Health Care System Drug Information Center. INTERVENTION: Provider inquiries and responses were extracted and characterized by indication for treatment and reason for inquiry. Comparison of the first and second 5-year periods was performed to delineate trends. Descriptive statistics, Fisher's Exact and χ2 tests were used for analysis. MAIN OUTCOME MEASURES: Inquiry origin, time, and subject. RESULTS: 433 inquiries were retrieved over the study period from physicians (50%), pharmacists (21%), and nurses (18%). Inquiries were most often made during the antepartum period (34%), followed by the postpartum (28%) and preconception (22%) periods. The most frequent indications for inquiry were psychiatry (15%) and infectious diseases (14%), which remained constant throughout the study period. Safety was the most common reason for inquiry (52%). The responses provided to callers were limited due to lack of information availability 37% of the time. CONCLUSION: Psychiatry and infectious disease-related indications are the most frequent subjects of provider inquiry regarding medication use in pregnancy. Rates of inquiry remained constant throughout the past decade in most therapeutic areas. These findings are consistent with previous observations in other developed countries and suggest high-yield areas for pharmacist education.

Implementing smart pumps for epidural infusions in an academic medical center.

PURPOSE: A hospital's initial experience with the implementation of new smart-pump technology for epidural drug delivery is described, with a discussion of challenges and lessons learned during the implementation process. SUMMARY: After a focused review of epidural medication use and prescribing patterns at the University of North Carolina Hospitals and Clinics (UNCH), a multidisciplinary team guided the selection of new smart pumps and the development of associated software tools. The new devices were programmed to display a "master drug library" of recommended drug concentrations, doses, and rates, which were consistent with newly created order sets intended to standardize prescriber ordering and nurse administration intended to help standardize prescriber ordering and nurse administration of adult and pediatric epidural infusions. However, data retrieved from the new units after several months of use indicated that nurses were still programming about 60% of epidural smart-pump infusions without using the onboard drug library (in effect circumventing the units' patient-safety software). In a survey of UNCH nursing staff, respondents indicated they were having difficulty in accessing the library and (when necessary) in manually programming the new devices. The hospital's experience highlighted a number of key points for institutions to consider during the implementation of new smart-pump technology. CONCLUSION: The implementation of new smart-pump technology for epidural infusions at UNCH revealed the importance of pump features and design in determining the devices' impact on patient safety. In particular, factors pertaining to ease of use (e.g., protocol-selection functions, programming procedures, data recording and retrieval capabilities) are crucial to the overall success of smart-pump implementation.